International Journal of Cancer Management
Volume:2 Issue: 3, Summer 2009

General Practitioners (GPs) have the main responsibility in medical and particularly palliative care provision in most of countries, though this is not the current case in Iran. Development of ''family physician'' approach in rural and most of the urban areas in Iran, GPs will have the main role in care provision. There is no formal palliative care education during general medical training in the country so far. Regarding the increasing number of people in need of palliative care services, it is essential to assess GPs'' knowledge about palliative care to develop special palliative care educational programmes. A cross-sectional questionnaire survey was conducted on general practitioners participated in a formal Continuous Medical Education programme, using three scales. 216 GPs returned the completed questionnaires. More than half scored their knowledge about palliative care as weak, which was significantly related to their previous experience in caring of a terminally ill patient (p=0.001). Less than one third stated their good ability to either assess or manage pain in end of life. Major gender differences were seen in different subscales such as communication with patients and carers, patient management, palliative care knowledge and skills, and psychological stress. This study revealed a profound lack of knowledge and experience among Iranian general practitioners about palliative care which was mostly in more complicated areas rather than common symptoms relief

This article was aimed to provide an overview and a perspective on the changing impact of cancers with increasing age on three age groups. A population based cancer registry was undertaken to register all new cancers cases from March 2006 to March 2007. During one year, 2023 (41.1%) of 4922 patients with cancer were ≥65 years. The five most common cancers (excluding skin cancer) were stomach, bladder, esophagus, prostate and lung in males and esophagus, stomach, breast, colorectal cancer and bladder in females. Taking into account the increasing life expectancy in Iran, establishment and implementation of national cancer control program should be of priority for health policy makers in this country.

Numerous studies have investigated the prevalence, incidence and clinical manifestations of gastrointestinal stromal tumors (GISTs). However, little is known about GISTs in Iran. This pioneer study focuses on description of 36 patients with GISTs in Iran. A database was created for 36 patients suffering from GIST who were treated in Loghman Medical Center and Tehran Cancer Institute in Tehran, Iran. Information on age, sex, clinical manifestations, treatment and outcomes were recorded and analyzed using SPSS version 13. Patients had an average age of 60 years; and 16 of them were males. The disease was most commonly manifested by abdominal mass, weight loss, and anemia. Twenty one patients had a mass smaller than 10cm; and in 33 patients KIT test was positive. In the follow-up, 5 patients experienced relapse and 3 succumbed due to advanced cancer. Primary results showed that GISTs might have different manifestations and incidence in Iran compared to other parts of the world. We hope that this study could serve as a starting point for the better understanding and classification of this disease in Iran and for development of improved management strategies.

It is more than 60 years that Fine Needle Aspiration (FNA) has been used for diagnosing palpable breast masses and has been known as an effective method for several years in Europe. In this study, we compared the diagnostic accuracy of FNA with open biopsy in Tabriz and Shiraz, Iran. We studied 100 patients with breast lesions in Tabriz Imam Khomeini Hospital from late September 2003 to late July 2004. FNA and open biopsy were done for all patients, FNA results were studied by pathologists in Tabriz imam Khomeini hospital and Shiraz University and pathological and cytological results were compared. According to cytology, 44% of samples were benign, 15% were suspicious, 33% were malignant and 8% were insufficient in Tabriz. These figures were 25%, 10%, 27% and 37%, respectively in Shiraz. Sensitivity of FNA was higher in Tabriz (89.79% vs. 69%) but specificity did not differ significantly in two groups (93.47% vs. 80.95%). Positive and negative predictive values were 97.77% and 89.36% in Tabriz and 100% and 60.6% in Shiraz, respectively. FNA accuracy was higher in Tabriz than in Shiraz (93.47% vs. 80.95%). If done by experts, FNA can be a reliable replacement for open biopsy in palpable breast masses. Evaluation of FNA samples during aspiration can decrease insufficient samples. FNA (at least in deprived areas) can be the first line of diagnosis in women with breast masses and is helpful to increase health standards and clinical supervision of patients.

Colorectal cancer (CRC) is one of the most common cancers in the world. During the past decades, survival of colorectal cancer patients has improved worldwide, however, it is not clear what factors have contributed to this development. This study was designed to evaluate the prognostic impact of a wide spectrum of pathologic parameters on survival rate in patients with colorectal cancer. 1127 patients with colorectal cancer who registered in one cancer registry in Iran were followed from their diagnostic date to Jan 1, 2007 (as failure time). Overall survival time was calculated by Kaplan-Meier method. The Cox proportional hazard model was used to identify the pathologic factors that could independently influence survival. The overall survival rate at 5 years after diagnosis was 61%. Histology grade, status of regional lymph node metastasis, distant metastasis and pathologic tumor stage were related to survival rate according to univariate analysis. Nevertheless, in multivariate analysis, only histology grade, distant metastasis and tumor size had influence on survival of colorectal cancer patients. Generally the prognosis of disease is not poor; however, distant metastasis, poor differentiation and higher tumor size should be considered to have additional risks of death in colorectal cancer.

Leukemia is the most common malignancy in childhood, and acute myeloid leukemia (AML) is the second most common leukemia. AML still accounts for more than 30% of deaths from leukemia. AML is classified into several subgroups from M0 to M7 with different presentations, clinical features, and outcomes. Between March 1996 and October 2003, 47 children with acute myeloid leukemia were treated with intensive chemotherapy using BFM-87 protocol after remission at Shafa hospital, Ahwaz, Iran. We compared the presenting features and outcomes of therapy in these children based on age, initial White Blood Cells (WBC) count, Central Nervous System involvement, FAB system types, and response to first induction treatment. Younger children were more likely to have favourable risks and less likely to have induction deaths (p=0.03) and lower relapse risks (p=0.001). FAB types M2 and M4 showed a better first remission rate (p=0.01, p=0.02, respectively), regardless of age and gender. Two major risk factors for relapse after first remission were initial high WBC counts (p=0.01) and older age at the time of diagnosis (p=0.02). Overall survival (p=0.001), event-free survival (p=0.001), and disease-free survival were better (p<0.001) in younger children due to lower relapse rates (p=0.001). Overall survival was 53% in the children with new AML who were on intensive chemotherapy with a median follow-up time of 5 years in our study. Relapse risk after first remission for the children who were on intensive chemotherapy alone was 34% in our study. Because of the potential morbidity and mortality usually related to allogeneic HSCT and also problems due to lack of sufficient HSCT possibility for some patients, several cooperative group trials now do not recommend HSCT for good- or standard- risk patients in their first remission. Results of our study were compatible with BFM, AML 10 and AML 12 groups trials in terms of overall survival, or relapse risk, or induction death risk factors

Depression is one of the most common and serious disorders that threaten human physical and psychological health. The incidence of depression in nurses who work in special wards compared to general wards has been debated for a longtime. In this study, we planned to compare the rate of depression and related factors between these two groups. Questionnaires about demographic factors, duration of daily work time and marital status were distributed randomly among 200 nurses working in special wards and 200 nurses working in general wards in 3 hospitals affiliated to Shahid Beheshti University (Modarres, Taleghani, Shohadaye Tajrish hospitals) in the summer and autumn 2006. The causes of admission of the patients were determined to assess their role in the occurrence of depression. To analyze depression, Beck depression inventory (BDI) score was used and the related intervening factors were compared between the two groups. The two groups were similar in sex (p=0.12), duration of daily work time (p=0.18) and marital status (p=0.23). The major cause of admission in special wards was malignancy (33.3 %) which was significantly higher than the rate of cancer patients in general wards (7.8%, p=0.03) (Table 1) Mean BDI score in special wards’ nurses and in general wards’ nurses was 9.3 ±7.36 and1±6.66, respectively. All nurses had some degrees of anxiety and stress, but there was no significant difference in the incidence of depression; however, it seems that exposure to numerous stressful experiences over a life time of nursing and a lack of control over these experiences contributed to the high level of anxiety and depression seen in all nursing groups. Although the intensive wards’ nurses were more involved with cancer patients compared to general wards’ nurses, the rate of depression did not show any significant differences in the two groups. Therefore, dealing with hopeless cancer patients did not increase the rate of depression in intensive wards’ nursing stuff and the intensive care environment does not seem to be more stressful for nursing staff in comparison with general care units.

Cervical cancer is one of the major causes of cancer and death among women aged 40 to 60 in developing countries. There is some difference, however, in the incidence of this cancer in Iranian women compared to women living in western and south-east Asian countries. We aimed at investigating the epidemiologic aspects and treatment results of cervical cancer among Iranian patients. Medical records of patients with cervical cancer who were referred to Mortazavi Radiation Oncology Center (Imam Hossein Hospital) between 2000 and 2004 were evaluated retrospectively. Clinical data such as stage of the disease, type pf chemotherapy, radiation technique and sequence of treatment was recorded. A total of 220 patients with a median age of 55 years (range: 28 to 89) were studied. The majority of them (37.3%) were referred with stage IIB of the disease. Other stages, in order of frequency, were IIA, IIIA and IB. Most of the patients (74%) were treated with two opposed field radiotherapy with a dose of 50 Gy or less (64%). Disease recurred in 46 patients (21%), 153 patients (74%) received two opposed field radiotherapy and 54 (36%) patients were treated with four fields. On the other hand, 113 patients (55%) did not receive brachytherapy, 36 (18%) only received ovoid brachytherapy and 56 (27%) were treated with ovoid and tandem brachytherapy. Recurrence was more prevalent if the radiotherapy dose was less than 50 Gy and also in patients treated with four-field box technique. The most frequent site of recurrence was pelvic area (71%). Our report revealed that most of the patients in Iran are diagnosed in advanced stages, a finding that can influence treatment results. Also, using external beam radiotherapy techniques, accessibility to brachytherapy devices and better patient support may improve treatment results.

Synchronous upper urinary tract tumor and superficial bladder tumor are uncommon. This is a report of a 62- year- old man presented with episode of painless gross hematuria and flank pain. We worked him up and found a left renal mass and bladder lesion. He underwent nephrectomy and TUR-BT, and the pathology report of both showed a high grade urothelial transitional cell carcinoma. The patient was followed by surveillance protocol for ureter stump. Our report included an uncommon case of high grade synchronous upper urinary tract and bladder transitional cell carcinoma.